Archive for July, 2019

Just over a month ago we had a brief but intense storm which did a bit of damage, including snapping the stem of this tomato plant. Most of the plant was at right angles to its base, but there was a thin sliver of stem still connected. So I got out a rather unorthodox gardening tool – gaffer tape – and taped it up around the break. (Reminded me of putting plasters on broken arms and legs!) And look at it now!

We had the first of the ripe tomatoes the other day and they were delicious.

Now part of me is just amazed at the resilience of plants, but mostly it makes me think about a fundamental characteristic of all living creatures, including human beings.

A new concept in science, and biology, started circulating a couple of decades ago. It goes by the name of “complex adaptive systems“. Basically, this applies to all forms of life because they all have vast interconnected networks of cells and molecules. When you get these vast networks certain characteristics appear, and, in the case of living organisms that includes “self-making capacity”, termed “autopoiesis” by Maturna and Varela. That means the ability to make itself, which encompasses growth, repair and reproduction. I find it a more useful term than the old “homeostasis” used in biology and Medicine, which suggested the maintenance of a stable, internal environment, but didn’t capture the key features of repair, growth and reproduction.

There’s an older term, not used very much in Medicine (I don’t know why), which is the ability to “self-heal”. I think self-healing is just an aspect of autopoiesis.

This is exactly what the story of this tomato plant demonstrates. The capacity of a living organism to heal, to repair, and to grow again – given the right support. And here’s the nub of what I want to say – that’s what we doctors actually do – we support self-healing. At least, that’s what we do when we don’t cause harm!

Yet it’s common to think that doctors can heal, that they can cure diseases. And it’s common for people to believe that drugs do that. They heal. They cure. Except they don’t.

Neither doctors nor drugs heal or cure.

What they do (optimally) is support self-healing. It is ALWAYS the organism which heals itself. There is no healing, no cure, without autopoiesis doing what it does. Which isn’t to say it can always do that all by itself. Nope, it might need help. That help, however, is not a substitute for self-repair and self-healing.

Good treatments can do one of two things – they can nurture the conditions for self-healing, or, they can directly stimulate some aspect of it.

Maybe it would be good to remind ourselves of that. The power of healing lies in the natural functions of the complex adaptive system. I think it’s worthwhile considering that when undertaking any form of treatment. Is this treatment going to nurture the conditions for my self-healing, or harm them? Is it going to directly stimulate some aspect of my self-healing, and, if not, then what is it doing?

Of course, there’s also a lot more to think about than just treatments. What nurtures the conditions for autopoiesis in my life? And what impairs it? That takes us into a whole related area of the environment, of food, movement, relationships, adequate housing and finance……what comes up for you when you start to consider that?

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This morning, at dawn, the clouds in the sky turned pink….a pink echoed in the flowers of this bush in the garden.

Pleasing, isn’t it?

It got me thinking about how often we come across this in life…..where there are resonances, where one phenomenon seems so “in tune” with another. When we encounter them I think we stumble across what is Beautiful, Good, and True. It thrills the mind, delights the heart, and enlivens the body.

Think for a moment about how we function, we human beings. There are so many individual cells within our body that nobody can count them. Billions of them. And here’s the amazing thing. They work together all the time. When our body is in a state of good health, all these cells, all our tissues, all our organs and our systems are working in harmony with each other.

Some people say they are “integrated”. What does that mean? I like Dan Siegel‘s definition –

integration is the creation of mutually beneficial bonds between well differentiated parts.

Notice the two elements of that definition.

“Mutually beneficial bonds”. Isn’t this a fundamental fact of life? We exist in relationship. As does every single cell and part of our being. A particular kind of relationship – a mutually beneficial one. We are perhaps the most social of creatures, wired and genetically determined to form bonds with others. If a newborn baby didn’t do that life wouldn’t last very long. We need the loving attention and care of others from the moment of our very first breath.

The second part of the definition is “well differentiated parts”. Uniqueness and diversity are also facts of life. No two cells are fully identical, not when we consider them in their contexts of time and space. We don’t develop healthy hearts and minds by making all the heart cells and brain cells the same. We need them to be different. But we need them to work in harmony with each other. Not in competition with each other.

When we live in harmony with others and with the rest of the planet I suspect we give ourselves the best possible chance of health and thriving. In fact, is this not the origin of “dis-ease”? Where we fall out of harmony with ourselves and our world? Maybe we need more emphasis on resonance and harmony, and less on competition and individualism…..


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This first photo is taken from my front door first thing in the morning.

The next one is taken at the end of the day, as the sun sets, casting a pink glow over the clouds and the moon (see that little white dot in the middle?) begins to shine for the night.

One of my favourite classical philosophical practices is “First and Last”.

It teaches us to remember that every moment we experience today comes into our life for the very first time. Although I can step out into the garden every summer morning and see this mulberry tree and the blue sky above and around it, I remember that I’ve never experienced it today before.

The tree doesn’t stay the same. Actually, this particular tree has grown enormously since we moved here five years ago. I have the notion its thriving because it enjoys our presence and our attention. I know the reciprocal is true – I feel part of my own thriving is down to the presence of this tree a few steps from the front door. Does it pay attention to me? Well, maybe that’s stretching things a bit too far, but my gut feeling says it’s at least aware of my presence. This year’s mulberry crop is a bumper one and I’m so glad that there are so many birds, of so many kinds, which enjoy eating them. I enjoy them too but sharing is so much more satisfying, don’t you think?

We lose something when we zip through life burdened with anxieties and ruminations. The “First and Last” teaching suggests that if we slow down we can become more aware of the unique context of every single experience. The differences from day to day might be subtle, or they might be huge, but they are always there. The morning I took this photograph was unique. I’d never woken up and stepped into this particular morning before.

At the end of the day I looked out of the window and noticed how pink the sky was, so I went outside and took this photo. You have to be quick when you take a photo of a sunset, or of the sky at sunset. The sun sinks astonishingly quickly, and the light and colours change within each second. A photo taken at this particular moment will be different from another one taken a minute or two later. It’s the same with every sunset.

This speed of change in the sky, this rapid sinking of the sun (which is actually the rapid rising of the horizon of the Earth as it turns, and not the Sun “sinking” at all!) makes me acutely aware of the second part of the teaching. Every moment we experience in this life, we experience, not just for the first time, but, also, for the last. If I want to capture the particular view I see in this moment, I’d better press that shutter, because in a few moments time, my chance will have gone, and taken with it the light and the colour.

Remembering that every single encounter we have, every single experience we have, every single moment in a day, will be our first AND our last opportunity to experience it makes it all so much more precious.

I think if you aren’t aware that this is your first and your last opportunity to experience today, then you aren’t paying enough attention! It’s never “just another day”!

I gave up saying “Seize the Day” before I even started saying it. I prefer to say “Savour the Day” instead…..or perhaps, even better, “Savour every single Moment” …… Try it. You might like it.

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This is one my favourite photos from a recent trip to Segovia in Spain. It shows examples of two classes of “things” – “things that change VERY slowly” and “things that change VERY quickly”!

First, the stones…….the Roman aqueduct in Segovia is the longest in tact aqueduct in Europe. It was completed in the 112 AD to take water from the Rio Frio 17 kilometres away into the heart of the city. Constructed with huge granite blocks placed on top of each other without any mortar to hold them together it functioned right up to the mid 19th century.

Isn’t it astonishing? I wonder how many of construction projects of the last 100 years will have this kind of longevity?

However, although it looks as if it is unchanged over almost 2000 years in fact part of it was destroyed by the Moors, and rebuilt in the 15th Century during the time of Ferdinand and Isabella. Also, there are some cracks in the granite now, due to pollution and water damage from leaks over the centuries. Still, 2000 years is a long time. In any one human life time these stones look like the kind of objects which keep their structure and form day after day, month after month, year after year.

Second, the clouds…….clouds are water droplets condensing and evaporating continuously. I challenge you to find the edge of a cloud! They just don’t keep their shape for more than a few seconds. They appear out of, and dissolve back into, the blue, blue sky around them…..constantly.

When we don’t stop to think about it, these are both objects, these stones and clouds, but they are SO different I sometimes wonder if we need to stop applying a single word to them both. They aren’t just “things”. But they are both beautiful, don’t you think?



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One of my most favourite cities is Segovia, in Spain. Perhaps its most striking feature is the Roman aqueduct. It begins as a pretty average sized wall, then column by column, arch by arch it gets bigger and bigger and bigger, straddling the town below until it reaches the old castle.

In this first part houses have been built on each side of it. I don’t think I’ve ever come across such an astonishing structure running right down the middle a street!

One of the first of the town’s squares lies at the foot of the aqueduct just as it reaches its greatest height.

I find this SO inspiring! Here’s what it got me thinking last time I was there…..

Throughout my career as a doctor I saw time as linear. Perhaps because the second half of my working life was in a specialist centre for people with chronic (long term) conditions, I commonly heard patients tell me of the traumas which they had experienced prior to becoming unwell.

I was never someone who bought into a mechanical, linear view of human beings, or of life. Every patient I met convinced me that all these chronic ailments are multi-factorial. You could never say that “this” caused “all that”. But there was one question I frequently found revelatory.

“When were you last completely well?”

Sounds an easy question, huh? But, actually, it was often difficult, and took some time and conversation to find the time, perhaps even several decades ago, when the patient last felt completely well. I’d then ask about the year the patient moved from wellness to illness.

“Tell me about that year”.

It was often a year of significant trauma, or the culmination of many traumas. I don’t think that meant that the patient’s illness could all be attributed to that trauma, but it was a starting point in making sense of their experience and beginning to find the way forward.

Sometimes patients were clearly stuck with these unresolved hurts. Again and again they’d think about those times, feel bad about them all over again. Others were so traumatised that they were living lives of fear, continually looking ahead and wondering “what if….?” “what might happen?” “how will I cope if….?” and things like that.

In both of these scenarios I’d draw a straight line – and say, the left hand point of this line is your date of birth, the right hand, the date of your death. We know the first, and have no way of knowing the second. But right now, today, you are somewhere along that line. Where is your attention? Where is your focus? Because if it’s to the left of today, it’s in the past, and that doesn’t exist any more, except in your memory. If it’s to the right, it’s in the future, and that only exists in your imagination. You can’t have your attention in more than one place at a time, so what if you draw your attention into the present instead? How might that feel? And we’d then explore ways of living more in the present reality, than in the past traumas and future fears.

I think it was often helpful, but now it seems somewhat simplistic to me. Because I now see time is not as linear as I thought. In fact, seeing cycles and seasons of time makes rather more sense to me now. As I experience a place like Segovia I realise that the past doesn’t go away. It doesn’t disappear into memory. (and memory is not an artificial place anyway….it’s no dusty filing cabinet with the drawers all locked)

Rather the past is always present, always here, and always now. It fashions our every day. It colours our every experience. It sets the tone of today. It constantly challenges us to respond to it, to adapt. In fact, that’s how we learn isn’t it? By having an awareness of the past in the present? If we forgot and discarded everything we experienced how could we learn anything? We adapt by carrying with us the past into the present.

And although this is even more challenging, the future is here now too. Not least because the future is, in one sense, a “multiplicity of singularities” – a set of possible paths, which are, at least in part, fashioned by this present moment, and by each and every decision and action.

I don’t think the past goes away. I don’t think the old “time heals” is true in the sense that it makes the past go away. Instead I think we learn to adapt to it. When we become aware of the past in our everyday we have the opportunities to create new responses, new strategies of living under it’s influence.

OK, so, this is not where I thought this post would go when I pasted in those photos of the aqueduct! But here’s a related thought – how does the presence of the past in today, as we see in this colossal aqueduct stretching over Segovia, shape, fashion, influence, inspire, challenge, stimulate the thoughts, feelings and actions of the people living there?

And so, of course, even when the past isn’t as obvious as this aqueduct, how does it’s presence today influence our experience of today?

Here’s the final part of that story – we don’t heal just by shifting our focus, we heal by becoming aware, aware of the past AND the future IN this present day, and realising we can change how we respond to that. Realising our current patterns aren’t fixed. We can alter them.

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I noticed this on a wall recently. First, I find this beautiful. I find it very appealing. Second, it expresses one of the commonest, most fundamental patterns in the universe – let’s refer to it as branching.

Because I’m doctor, I often start by thinking about the human body, and in the body there are many, many examples of this branching structure. Perhaps the most obvious in the respiratory system. We breathe in air and it travels down the trachea (some people call the trachea “the windpipe”). After a short distance it branches into two tubes, one heading to the left lung and one to the right. From there on there, the pattern repeats, branching into smaller and smaller passageways, until, the smallest ones end in little bunches of grapes, called “alveoli” (OK, I know, they aren’t actually grapes! They just look a bit like that!) Similarly, the vessels which distribute the blood around the body, start from a big one right out of the heart, which branches into smaller and smaller vessels, the further away it gets from the heart, till in the tips of our toes and fingers, in the skin, the vessels become hair like (“capillaries”). The blood then gets back to the heart following a similarly patterned set of vessels (“veins”) coursing along the tiny ones, which join together to make bigger and bigger ones, till one big one channels all the blood back to the heart.

Does that pattern remind you of anything? The journey from mountain springs to river estuaries perhaps? Or trees!

Sometimes I wonder if that’s one of the reasons we find trees so appealing? That they echo one of our most fundamental internal structures.

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This made me stop. It looks like two trees who got together a long time ago, and have continued to grow, relate, entwine, even dance and kiss together ever since!

The physicist, Carlo Rovelli, says “the universe is made up of networks of kisses, not stones

He also says

I think that quantum theory can make sense as it is: we just have to give up some cherished metaphysical prejudices and accept the deep relational aspect of nature that the success of the theory has revealed

Another physicist, Lee Smolin, says “the universe is a network of events”.

Asked about his theory he says

It’s a theory about processes, about the sequences and causal relations among things that happen, not the inherent properties of things that are. The fundamental ingredient is what we call an “event.” Events are things that happen at a single place and time; at each event there’s some momentum, energy, charge or other various physical quantity that’s measurable. The event has relations with the rest of the universe, and that set of relations constitutes its “view” of the universe. Rather than describing an isolated system in terms of things that are measured from the outside, we’re taking the universe as constituted of relations among events. The idea is to try to reformulate physics in terms of these views from the inside, what it looks like from inside the universe.


Aside from physicists, daily life begins to take on a different flavour altogether when we shift our focus from things to events, from objects to relationships, from separate items to connected contexts.

Try it for yourself, see what’s it like to focus more on kisses, relationships and events than on “stuff”.

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